CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 205 504.250000 18758.1000 37.2000
Subtotal (Total Children Is Unduplicated) 205 504.250000 18758.1000 37.2000
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Total 504.250000 18758.1000 37.2000
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Number of Children (Unduplicated) With at Least One Service 205
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Center 05
Flag Claims Units Chgs Paid
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R 7 5.750000 213.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 944 467.500000 17391.0000 13299.0700
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13 5.500000 204.6000 0.0000
Other 41 25.500000 948.6000 0.0000
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Total 1005 504.250000 18758.1000 13299.0700